14例HIV阴性马尔尼菲篮状菌感染患者的临床特点分析

Clinical characteristics of 14 cases of HIV negative Talaromyces marneffei infection

目的通过分析人类免疫缺陷病毒(human immunodeficiency virus,HIV)阴性的马尔尼菲篮状菌(Talaromyces marneffe,TM)感染患者的临床特点,提高对该病的认知。方法回顾性分析2016年1月至2022年1月深圳市第三人民医院收治的14例HIV阴性TM感染患者临床资料,总结HIV阴性TM感染患者的临床特点。结果14例HIV阴性TM感染患者年龄(46.71±18.93)岁。确诊方式:血培养2例,痰培养4例,病灶脓液或组织培养3例,宏基因组二代测序5例。患者自发病到明确诊断的中位时间为30 d,其中出现骨质破坏患者的诊断中位时间为180 d。14例患者中,发热10例次、肺部感染10例次、咳嗽咳痰7例次、贫血10例次、消瘦7例次、炎性丘疹或溃疡等皮肤病变5例次、肝脾肿大4例次、真菌血症2例次、骨质破坏3例次。2例患者误诊为骨结核,5例患者误诊为肺结核并行抗结核治疗。抗真菌治疗后,治愈11例,死亡3例。结论HIV阴性TM感染病与HIV阳性TM感染患者的临床表现类似,但TM感染肝脾肿大及真菌血症发生率较少,无基础疾病的患者容易出现骨质破坏,容易误诊或延迟诊断。宏基因组二代测序技术可作为诊断的重要工具。

Objective To analyze the clinical characteristics of HIV negative patients with Marneffei basket disease and improve their understanding of the disease.Methods A total of 14 cases of HIV negative Marneffe’s disease admitted to the Third People’s Hospital of Shenzhen from January 2016 to January 2022 were analyzed and summarized.The clinical characteristics of HIV negative Marneffe's disease patients were analyzed and summarized.Results The majority of HIV negative patients with Marneffei basket form bacteria with an age of(46.71±18.93)years.Diagnosis methods:bl ood culture in 2 cases,sputum culture in 4 cases,pus or tissue culture of lesions in 3 cases,and metagenomic second-generation sequencing technology in 5 cases.The median time from onset to definitive diagnosis in patients is 30 days,with a diagnosis median time of 180 days for patients with bone destruction.Main clinical features:10 cases of fever,10 cases of pulmonary infection,7 cases of cough and phlegm,10 cases of anemia,7 cases of emaciation,5 cases of inflammatory papules or ulcers and other skin lesions,4 cases of hepatosplenomegaly,2 cases of mycosis,and 3 cases of bone destruction.Two patients were misdiagnosed as bone tuberculosis,and five patients were misdiagnosed as pulmonary tuberculosis and received anti tuberculosis treatment,with a misdiagnosis rate of 50%.After antifungal treatment,3 patients died.Conclusions There is no significant specificity in the clinical manifestations of HIV negative and HIV positive Marneffe’s disease patients.The incidence of hepatosplenomegaly and mycosis is relatively low,and patients without underlying diseases are prone to bone destruction,which can lead to misdiagnosis or delayed diagnosis.The second-generation sequencing technology of metagenes can serve as an important tool for auxiliary diagnosis.